Switch to managed care nears for Ohio

Clients must choose one of three providers by Nov. 1.
By ED RUNYAN
VINDICATOR TRUMBULL STAFF
Patrick Duricy is hoping Trumbull County doesn't see a return to the problems of several years ago, when a managed-care program for Medicaid left clients with a multitude of problems getting health care and having those bills paid.
Duricy, managing attorney for Community Legal Aid Services, is one of a handful of officials who attended a recent county Human Services Community Planning Committee meeting. They are alarmed that managed care is returning to the county's Medicaid program.
Some 1.2 million clients on Medicaid statewide in the Covered Families & amp; Children group were notified recently they would have to choose among three companies to handle their services. The three are Gateway Health Plan and Unison Health Plan, both of Pittsburgh; and Care Source of Ohio, companies Duricy refers to as "Medicaid HMOs."
Clients have until Nov. 1 to make a selection. If no selection is made, a company will be selected for them, said John Barley, chief of the bureau of Managed Health Care within the Ohio Department of Job and Family Services.
Clients in Mahoning and Columbiana counties are in the midst of the same change. Mahoning County clients in the Covered Families & amp; Children group also have until Nov. 1 to choose a provider. Columbiana County clients will receive letters on the change sometime next spring, Barley said.
Previous difficulties
The official said the state used a managed-care system before, but Barley said that ended in 2000 in the wake of troubles with some of the companies that administered the plans; one even had trouble paying claims.
Barley said this time will be better because the companies selected to administer services are large multistate companies and will be better monitored by the Ohio Department of Insurance. He said the companies administering the services before were generally smaller hospital-based health maintenance organizations.
The companies they are using have been in the business quite a while and will be better able to handle the job, he said.
Duricy said the system was a "disaster" the previous time.
Thomas Mahoney, Trumbull County Department of Job & amp; Family Services director, agreed that the program didn't run well before and expressed concern about the selection process clients will use to pick a provider.
The tough part for JFS officials is that they are not allowed to give the clients information about the three companies. That's because their comments could be construed as giving preference to one of the companies, said Gladys Velez, director of the JFS senior-citizen division.
She said she heard it is difficult to get information from the companies' 800 numbers.
Barley said the companies with which the state contracted were required to adhere to national standards for call centers -- such as having to answer a call within a certain amount of time.
Improvements planned
Barley admits the reason for the change to managed care, which was mandated in the last state budget, is to save money. Nonetheless, he said several improvements are planned, such as:
UMailing to each client a consumer guide that details the three companies, explains managed care and explains the benefits.
U A phone number to call each company for more information and to make selection of one of the plans.
U A 24-hour-per-day, seven-day-per-week nursing line for medical advice.
"I think there are some positive changes," Barley said. For those who do not pick a managed-care company by the deadline, Barley said, the state will select one that they feel will best serve the client's medical history, such as trying to keep them with a provider that uses the same doctors they have used in the past.
If the state makes the selection, the clients will be told they can still call if they "don't like the choice," he said.
Barley said managed care is also coming to Medicaid recipients who are aged, blind or disabled. He said about 125,000 statewide of the 400,000 people in this classification will have to get into a managed-care system by about this time next fall. Only 125,000 are affected, he said, because some people will be exempted, such as most elderly people and those living in nursing homes.
Reducing expenses
The change in Medicaid is just one way the Ohio Department of Job and Family Services has tried reduce expenses, Mahoney said. Another way was to carry out an early retirement program in Trumbull County.
Mahoney said 21 employees in his agency took the buyout, which has made recent months difficult, as new people replaced veterans. He said the loss of those veterans caused an "information drain" or "information gap" of people who understood the rules and regulations.
"We lost some very good people," he said of the buyout. "I'm glad it doesn't happen very often."
Another cost savings will come from the planned joining of the Department of Job & amp; Family Services, the Child Support Enforcement Agency and the One-Stop job training center. Currently those three agencies are in separate buildings, but the county commissioners have been trying to merge them into one facility.